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Preventive Care

Take Control of Your Health

Preventive care like physical exams and periodic screenings can help detect illness or health risks early. That's why all the PPOs and HMOs the State offers include coverage for preventive care and immunizations.

If you enroll in a PPO…

Specific preventive care services and immunizations are covered; see more information below

  • Network: Reimbursed at 100% of allowed amounts, no deductible
  • Non-network: Reimbursed at 100% of the non-network allowed amount; you are responsible for amounts above the non-network allowed amount.

If you enroll in an HMO…

Similar preventive care services are covered; check with the specific HMO for more details.

More about PPO Preventive Care and Immunization Benefits

  • For Children: The PPO plans cover pediatric preventive care and immunizations as recommended by the American Academy of Pediatrics in accordance with Florida Statutes s.627.6579. The recommendations can be viewed at the following websites: www.cispimmunize.org and www.aap.org/visit/prevent.htm.
  • For Adults: Services are covered based on prevailing medical standards and recommendations of the U.S. Preventive Task Force and the American Academy of Family Physicians for someone who has no symptoms or risk factors. Ages and frequency may vary based on risk factors such as family history. The chart below provides some examples of those guidelines. While we attempt to keep this as up-to-date as possible, you may view a more complete, current list of recommendations at the American Academy of Family Physicians web site under "Clinical Care & Research."
Service/Immunization Male* Female*

Cholesterol

Age 35, every 5 years

Age 45, every 5 years

Pap Smear

 

Annually

Blood Pressure Check

Age 21 and up, annually

Age 21 and up, annually, as determined by physician

Mammogram
(not fully covered, subject to plan deductible)

  
  • One baseline between ages 35-39
  • One every 2 years, ages 40-49
  • One every year, ages 50 and up
  • Any age and interval as medically necessary

Prostate Specific Antigen (PSA)

Age 50, annually

 

Osteoporosis - bone density test

 

Age 65 and up, as determined by physician

Measles/mumps/rubella (MMR) immunization

 

Age 18-50, once

Colorectal Cancer Screening

  • Fecal occult blood test (FOBT)
  • Double contrast barium enema
  • Flexible sigmoidoscopy


  • Colonoscopy

 

  • Age 50, every year or
  • Age 50, every 5 years


  • Age 50, every 10 years

Hearing and vision

Annually

Tetanus-Diptheria (TD) immunization

Age 18 and up, every 10 years

Immunization against pneumonia

Age 65 and up, once

Flu shots

Age 50 and up, every year

*Based on asymptomatic and/or zero risk factor patients. Age intervals and frequency may vary based on risk factors such as family history.